Abortion-Doctor Regulations: Protecting Women or Restricting Access?

Two states have passed laws this month that require doctors to have hospital privileges to perform abortions. Critics say the laws will have little impact on women's health and are purely politically motivated.

As several states have passed laws requiring doctors who perform abortions to have a formal relationship with a nearby hospital, opponents argue such policies are an underhanded way of restricting abortion access, while supporters say they're important for protecting women’s health. So which is it?

The answer, of course, depends on who you ask. But the empirical evidence suggests that these new laws will have a limited effect on women’s health, considering the documented safety of abortion procedures in the modern age and other realities about the U.S. health-care system.

“Abortion, as it's being currently provided and the way it's currently being regulated, is really very safe. It has a very low rate of complications,” says Daniel Grossman, a vice president for research at Ibis Reproductive Health, a non-profit research center, and former vice chair with the American Congress of Obstetricians and Gynecologists (ACOG). He cited a January 2013 study published in the American Journal of Public Health that found that out of 11,500 abortions performed in California from 2007 to 2011, six (or 0.05 percent) had major complications that required hospitalization.

“I’ve not seen any evidence put forward that women are getting substandard care when they have complications because the abortion physician doesn't have admitting privileges,” Grossman says. “It's really just been used as a strategy to shut down abortion clinics.”

Wisconsin Gov. Scott Walker signed a law two weeks ago that requires doctors who perform abortions to have admitting privileges at a nearby hospital -- a move that, according to the abortion clinics that immediately sued the state, would close half of the clinics offering abortions. Citing a "troubling lack of justification," a federal judge delayed enforcement of the law until it gets a court hearing. A bill passed last week by the Texas legislature, expected to be signed soon by Gov. Rick Perry, contained the same requirement.

According to the Guttmacher Institute, a nonprofit that supports abortion rights, seven other states -- Alabama, Arizona, Kansas, Mississippi, North Dakota, Tennessee and Utah -- have a requirement that abortion doctors have hospital privileges. Like Wisconsin’s, the laws in Alabama and Mississippi have been delayed in the courts.

The Mississippi law, passed in 2012, has been particularly contentious because, if implemented, it would likely lead to the shutdown of the state’s only abortion clinic. Pro-choice advocates have pointed to comments by the state’s pro-life legislators as evidence that they’re more interested in limiting abortion access than protecting women’s health.

"I believe life begins at conception and I think a lot of Mississippians do as well,” Mississippi state Rep. Sam Mims, who sponsored his state’s bill, told CNN last November. “If this legislation causes less abortion, then that's a good thing.”

Not everyone in the medical community is against requiring hospital privileges for abortion doctors, though. Kathleen Raviele, an Atlanta OB-GYN and past president of the Catholic Medical Association, which opposes abortion generally, says the requirement ensures that a doctor would be able to accompany a patient to the hospital in the event of a major complication, she says. Most doctors, particularly OB-GYN's, already obtain hospital privileges if they're going to perform any kind of surgical procedures, she says, so putting the practice into law shouldn't add a significant burden.

"When you're doing the procedure, you're the captain of the ship. You have to be following through to make sure the patient is cared for," she says. "You don't simply dump the patient on the hospital. That's not good medicine."

No official statistics are available on the number or percentage of doctors with hospital admitting privileges. Pro-choice advocates acknowledge that many abortion doctors might already have such privileges, but still contend that these formal requirements are unnecessary and burdensome.

Raviele also questions whether abortion was as safe as some allege, pointing out that the Centers for Disease Control and Prevention collects data on complications that's voluntarily reported.(The American Journal of Public Health study did not rely on voluntary reporting).

Critics of these laws, however, argue that beyond abortion’s general safety, these policies will have a limited impact on women’s health for two reasons.

One, the federal Emergency Medical Treatment and Active Labor Act requires hospitals to treat anyone who comes to their emergency room in need of urgent medical care regardless of their ability to pay, citizenship, etc. That means, pro-choice advocates say, that even if a woman has an abortion performed by a doctor without hospital privileges, she’ll still be able to receive emergency treatment at a hospital in the event of a major complication.

“No matter where a woman shows up, she's going to be treated at the ER,” says Elizabeth Nash, state issues manager at the Guttmacher Institute. “This doesn't affect her ability to access medical care.”

The second is the reality that many women seek abortions far away from where they live. Because abortion complications often take time to develop, Grossman says, women are more likely to seek emergency care at the hospital nearest to their home, which makes any requirement that their abortion doctor have hospital privileges irrelevant. An Ibis survey of six Texas cities, undertaken in response to the legislation there, found that women traveled 42 miles on average to have an abortion.

There is one other indication that these policies might be more about abortion access than health care: No analogous requirement exists for any procedures aside from abortion. The American Hospital Association has declined to take a position on the new laws, but Nancy Foster, the association’s vice president for quality and patient safety policy, says she isn't aware of any similar policies for other kinds of operations.

“Not to the best of my knowledge,” she says.

Checking Up on Health News: links to stories you may have missed from around the Web

I'm not sure yet what the public policy implications are, but a new study found minority children are less likely to be diagnosed with ADHD, CalorieLab reports.

Alan Weil of the National Academy of State Health Policy wisely calls for calm amid the hysteria over the initial prices of health exchange coverage.

California cities are struggling with how exactly to regulate e-cigarettes, the San Gabriel Valley Tribunereports.

Interesting intellectual exercise from American Committment, a free-market think tank, on how people would have responded if President Romney delayed the ACA's employer mandate like President Obama did.

Confused about the difference between exchange premium tax credits and cost-sharing subsidies? This Kaiser Health Newsprimer should clear things up.